{"id":50557,"date":"2021-06-30T19:01:04","date_gmt":"2021-06-30T18:01:04","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=50557"},"modified":"2021-07-21T12:12:06","modified_gmt":"2021-07-21T11:12:06","slug":"health-and-wealth-in-pandemic-times-not-a-zero-sum-game","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2021\/06\/30\/health-and-wealth-in-pandemic-times-not-a-zero-sum-game\/","title":{"rendered":"Health and wealth in pandemic times: not a zero-sum game"},"content":{"rendered":"

Sajid Javid’s policy of \u201copening up\u201d seems ill-timed. Since his appointment as the new secretary of state for health and social care, on Saturday 26 <\/span>June, another 100,000 people in the UK have developed covid-19. Hundreds of thousands of <\/span>adults<\/span><\/a> and <\/span>schoolchildren<\/span><\/a>, contacts of positive cases, are currently isolating. <\/span>Sporting events<\/span><\/a> and <\/span>festivals<\/span><\/a> have been cancelled. Yet, lockdown restrictions\u2014including physical distancing, the “rule of 6” for meeting indoors, and masking in public places\u2014are set to be summarily withdrawn on 19<\/span>th<\/span> July 2021.\u00a0<\/span><\/p>\n

Javid is correct that health depends on a thriving economy. He is correct that measures introduced to contain the virus\u2014including self-isolation by workers and citizens; closure of factories, offices, and shops; and cancellation of public events\u2014will lower economic activity, reducing the circulation of money and hence tax revenue (from which public services are funded). [<\/span>1]<\/span> He is correct that lockdown has taken a heavy toll on the nation\u2019s mental health and wellbeing,<\/span> though there is no evidence that suicides have increased.[2,<\/span>3]<\/span> He is rightly concerned about <\/span>vulnerable children<\/span><\/a>.\u00a0<\/span><\/p>\n

But since the fundamental nature of the crisis is virological, not economic, we cannot simply <\/span>\u201cgrow our way out of it.\u201d<\/span><\/a> Indeed, against a clear trajectory of exponential growth at the beginning of a likely third wave of covid-19, phrases like an <\/span>\u201cirreversible road to freedom\u201d<\/span><\/a> appear populist and na\u00efve.\u00a0<\/span><\/p>\n

It is more than a year since I debated with economist Andrew Sentence that pitting economic recovery against public health in a <\/span>crude zero-sum game<\/span><\/a> could be devastating for the UK. The highly transmissible and serious delta variant, which may have entered the UK as a result of <\/span>delayed border closure<\/span><\/a> linked to a hoped-for trade deal with India,<\/span> will leave much economic damage in its wake. [4]<\/span><\/p>\n

The recent announcement that <\/span>senior executives<\/span><\/a> may temporarily leave quarantine in England if they are undertaking business activities which will bring \u201csignificant economic benefit\u201d to the country suggests that the new secretary of state has yet to read Andrew Nikiforuk\u2019s eloquent essay “The Pandemic Speaks<\/a>“:\u00a0<\/span><\/p>\n

\u201cYour [political] leaders scoffed at what needed to be done, because they deemed such responses extreme. They could not imagine how small individual risks could rapidly amplify into collective tragedies. And so they moved like molasses to limit mobility, and then acted like a spring melt to open things up again, providing me with the advantage time and time again. They all thought they could turn me off like some computer game. My gratitude for such ineptness is truly boundless.\u201d<\/span><\/i><\/p>\n

Drawing partly on previous publications from health economists, <\/span>I encourage the secretary of state to consider five measures designed to <\/span>align<\/span><\/i> public health goals with economic ones. [1,5]<\/span><\/p>\n

First, prioritise preventing disease. Sick workers are unproductive, contagious, and costly<\/span>\u2014especially if they go on to develop the protracted sequelae known as long covid. [5] Community engagement is needed to improve vaccine uptake in vulnerable groups. [<\/span>6]<\/span> The SARS-CoV-2 virus is airborne,<\/span> so anyone who shares indoor air with an infected person, whether or not within some arbitrary (e.g. 2-metre) distance, is at risk. [7,<\/span>8]<\/span> In the short term, this means persisting with indoor masking, <\/span>and attending to ventilation, air filtering, and CO2 monitoring (a measure of stale air). [9-<\/span>11]<\/span> In the longer term, it means investment to change the way public buildings are designed. [<\/span>12]<\/span><\/p>\n

Second, protect the poor, who suffer a double burden\u2014they are more likely to catch covid-19 and have an adverse outcome, and are also more vulnerable to the economic impacts of lockdown. [<\/span>13]<\/span> Until nobody on a zero-hours contract has to choose between self-isolating and feeding their family, community transmission of the virus will continue apace.\u00a0<\/span><\/p>\n

Third, protect businesses from financial risk. To the extent that businesses lack the resilience to withstand shocks, a pandemic-related hit may prove irreversible. A company that closes, for example, may never reopen if the skilled labour on which it depends is lost; a middle-aged worker made redundant may never return to employment, and so on. [<\/span>1]<\/span> Measures to soften this hit\u2014such as interest-free loans, deferred taxes, and furlough\u2014are likely to bring dividends in the future.\u00a0<\/span><\/p>\n

Fourth, control profiteering. The pandemic has enabled those seeking to make vast personal profits out of a global tragedy by selling household goods, or substandard protection at inflated prices, or reaping financial gains from opportunistic investment. [<\/span>14,15]<\/span> For everyone who profits, many will be thrown further into poverty.\u00a0<\/span><\/p>\n

Finally, strengthen health services\u2014especially primary care. There is a pandemic-driven backlog of unmet need in every branch of medicine, with everything from psychosis to cancer being diagnosed at a later, more expensive-to-treat stage. [<\/span>16]<\/span> Countries with strong primary care services\u2014based on personal relationships and continuity of care\u2014have better overall health, longer survival and lower overall healthcare costs than those without. [<\/span>17]<\/span>\u00a0<\/span><\/p>\n

As a former Chancellor of the Exchequer, Javid brings important knowledge of economics to his new brief. Rather than turning his back on public health, he should work quickly and collaboratively with his new department to avert further damage from the continuing pandemic.\u00a0<\/span><\/p>\n

Trish Greenhalgh,\u00a0<\/i><\/b>professor of primary care health sciences,<\/i>\u00a0University of Oxford, UK.<\/i><\/p>\n

Competing interests<\/i><\/b>: none declared.<\/i><\/p>\n

Acknowledgements<\/strong>: Thank you to Martin McKee for advice on sources<\/em>.<\/p>\n

References:<\/strong><\/p>\n

    \n
  1. McKee M, Stuckler D. If the world fails to protect the economy, COVID-19 will damage health not just now but also in the future. <\/span>Nature Medicine<\/span><\/i> 2020;26(5):640-42.<\/span><\/li>\n
  2. Tsamakis K, Tsiptsios D, Ouranidis A, et al. COVID<\/span>\u2011<\/span>19 and its consequences on mental health. <\/span>Experimental and therapeutic medicine<\/span><\/i> 2021;21(3):1-1.<\/span><\/li>\n
  3. Appleby L, Richards N, Ibrahim S, et al. Suicide in England in the COVID-19 pandemic: Early observational data from real time surveillance. <\/span>The Lancet Regional Health-Europe<\/span><\/i> 2021;4:100110.<\/span><\/li>\n
  4. Mlcochova P, Kemp S, Shanker Dhar M, et al. SARS-CoV-2 B.1.617.2 Delta variant emergence and vaccine breakthrough. <\/span>Research Square<\/span><\/i> 2021;preprint <\/span>https:\/\/doi.org\/10.21203\/rs.3.rs-637724\/v1<\/span><\/a>.<\/span><\/li>\n
  5. Gros C, Valenti R, Valenti K, et al. Strategies for controlling the medical and socio-economic costs of the Corona pandemic. <\/span>arXiv preprint arXiv:200400493<\/span><\/i> 2020<\/span><\/li>\n
  6. Burgess RA, Osborne RH, Yongabi KA, et al. The COVID-19 vaccines rush: participatory community engagement matters more than ever. <\/span>The Lancet<\/span><\/i> 2021;397(10268):8-10.<\/span><\/li>\n
  7. Greenhalgh T, Jimenez JL, Prather K, et al. Ten scientific reasons why we know SARS-CoV-2 is airborne. <\/span>Lancet<\/span><\/i> 2021;in press<\/span><\/li>\n
  8. Jones NR, Qureshi ZU, Temple RJ, et al. Two metres or one: what is the evidence for physical distancing in covid-19? <\/span>bmj<\/span><\/i> 2020;370<\/span><\/li>\n
  9. Chernozhukov V, Kasahara H, Schrimpf P. Causal impact of masks, policies, behavior on early Covid-19 pandemic in the US. <\/span>Journal of Econometrics<\/span><\/i> 2021;220(1):23-62.<\/span><\/li>\n
  10. Czypionka T, Greenhalgh T, Bassler D, et al. Masks and face coverings for preventing the spread of Covid-19: a narrative review. <\/span>Annals of Internal Medicine<\/span><\/i> 2020:doi.org\/10.7326\/M20-6625.<\/span><\/li>\n
  11. SAGE-EMG. Role of ventilation in controlling SARS-CoV-2 transmission. London: Scientific Advisory Group on Emergencies 2021:<\/span>https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/928720\/S0789_EMG_Role_of_Ventilation_in_Controlling_SARS-CoV-2_Transmission.pdf<\/span><\/a>.<\/span><\/li>\n
  12. Morawska L, Allen J, Bahnfleth W, et al. A paradigm shift to combat indoor respiratory infection. <\/span>Science<\/span><\/i> 2021;372(6543):689-91. doi: 10.1126\/science.abg2025<\/span><\/li>\n
  13. Bambra C, Riordan R, Ford J, et al. The COVID-19 pandemic and health inequalities. <\/span>J Epidemiol Community Health<\/span><\/i> 2020;74(11):964-68.<\/span><\/li>\n
  14. Smith G. Pandemic Pirates: An Essay Calling for Legislation Curbing Pandemic Profiteering. <\/span>Lincoln Memorial University Law Review Archive<\/span><\/i> 2021;8(2):1.<\/span><\/li>\n
  15. Neely M, Carmichael D. Profiting on Misery: how predatory shadow banks have exploited the coronavirus crisis (blog). LSE blogs: <\/span>https:\/\/blogs.lse.ac.uk\/researchingsociology\/2021\/04\/20\/profiting-on-misery\/<\/span><\/a> 2021.<\/span><\/li>\n
  16. Jones D, Neal RD, Duffy SR, et al. Impact of the COVID-19 pandemic on the symptomatic diagnosis of cancer: the view from primary care. <\/span>The Lancet Oncology<\/span><\/i> 2020;21(6):748.<\/span><\/li>\n
  17. Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. <\/span>The milbank quarterly<\/span><\/i> 2005;83(3):457-502.<\/span><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Sajid Javid’s policy of \u201copening up\u201d seems ill-timed. Since his appointment as the new secretary of state for health and social care, on Saturday 26 June, another 100,000 people in […]<\/p>\n

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